Special Issues for Women After Bariatric Weight-Loss Surgery

Special Issues for Women After Bariatric Weight-Loss Surgery.

Special Issues for Women After Bariatric Weight-Loss Surgery

 

Diane E. Judge, APN/CNP

 

Be prepared to prevent or delay pregnancy and maintain bone health.

 

Bariatric surgery — operations such as gastric sleeve, gastric band, and Roux-en-Y gastric bypass that change the digestive tract — has enabled many obese people to approach and maintain a healthy weight while controlling life-threatening obesity-related medical conditions like heart disease, sleep apnea, diabetes, and high blood pressure. More than half of those who have benefitted from bariatric surgery are women, mostly in their childbearing years. If you are a woman considering bariatric surgery, you should be aware of some special issues.

Choose and Use an Effective Method of Pregnancy Prevention

It's generally a good idea to avoid pregnancy before most surgeries because of the stress placed on your body and the drugs that may be used during and after the operation. Most medical experts agree that women should delay pregnancy for 1 to 2 years after bariatric surgery. This type of surgery enables you to lose weight by altering your body's ability to absorb the nutrients in food — which also means that, if you get pregnant too soon, the fetus might not get the nutrients it needs to grow and develop normally. Once your nutrition has improved (usually with the help of a specialist such as a dietitian), your body can provide a better environment to support a healthy baby.

Even if you were unable to get pregnant before, you will need an effective method of contraception (pregnancy prevention). Women who are very overweight commonly don't release eggs from their ovaries, don't have regular periods, and have difficulty becoming pregnant. With weight loss after bariatric surgery, your ovaries may begin working normally again, making pregnancy possible.

The Most Effective Methods: IUDs and Implants

Whether you don't want to have children or you need to delay pregnancy for a while after surgery, consider one of the “get it and forget it” methods — the intrauterine device (IUD) or implant. These are the most effective methods available and do not require you to do anything other than decide to use them and have them placed (the IUD goes into the uterus, and the implant is inserted under the skin of the upper arm) by a clinician (doctor, nurse practitioner, nurse midwife, or physician assistant) during an office visit. There are several types of IUDs; the longest lasting can prevent pregnancy for up to 12 years. The implant works for up to 5 years. Either method can be removed in a brief office procedure if you are ready to get pregnant or want to stop using it. Your ability to become pregnant should return quickly.

Hormone-Containing Methods: Pill, Patch, Vaginal Ring, Shot

You can also choose to take a pill daily, use a contraceptive patch weekly, insert a vaginal ring monthly, or get a shot every 3 months. These methods are all considered safe after weight-loss surgery. However, some types of bariatric surgery (such as gastric bypass) may decrease the amount of hormones you can absorb from pills; therefore, pills may not work as well as other methods, and it's reasonable to suggest that you choose this option only if you are unable or unwilling to use other methods. The hormones in the patch are absorbed through the skin, those in the ring are absorbed through vaginal tissue, and those in the shot are absorbed from muscle or tissue under the skin. These methods do not depend on the digestive tract, so bariatric surgery does not affect how well they work. You should be aware, however, that some women gain weight with the shot.

If you are not satisfied with the contraceptive method you have chosen, talk to your clinician about changing methods until you find one you're comfortable with and can use correctly and consistently. If you are having unwanted side effects (such as irregular bleeding or spotting with the IUD or shot), check with your clinician to see if these problems can be controlled. Most side effects improve on their own after a few months of method use.

If You Do Become Pregnant

If you get pregnant within a year or two after bariatric surgery, you should work with a clinician and a nutrition expert to make sure you get proper nutrition. You will probably need to take nutritional supplements to provide the correct amounts of vitamins and minerals to the developing fetus. Regular blood tests to check nutrient levels will likely be recommended throughout the pregnancy.

Keeping Your Bones Healthy

Like all women who lose a large amount of weight, those who lose weight after bariatric surgery are apt to experience bone thinning, possibly causing bones to break easily. Although we generally think of osteoporosis (thinning bones) as something that occurs after menopause, even younger women can experience this problem after bariatric surgery. You will probably be advised to take calcium and vitamin D to help prevent bone loss, and the levels of these nutrients in your blood will be tested regularly. If you are postmenopausal (periods have stopped for at least 1 year), your clinician may recommend a test to check your bones before surgery and at regular intervals thereafter. As to when and how often these tests should be done, your clinician's recommendation should be individualized to you.

In addition to the above measures, if you are a smoker, quitting can help keep your bones healthy while also benefitting your health in other ways. Ask for help with smoking cessation; many effective options are available. Avoid excessive alcohol; you should not have more than 2 alcoholic drinks daily and not more than 7 weekly. Regular exercise also helps maintain bone strength.

In Conclusion

Bariatric surgery has many benefits for obese women who have been unable to lose weight and/or have health conditions caused or worsened by excessive weight. After surgery, delaying pregnancy for 1 to 2 years is advisable; you should choose a contraceptive method that will work for you. In addition, be aware that changes in how you absorb vitamins and minerals after surgery may make osteoporosis a possibility. Work with your bariatric surgery team on measures to protect your bone health.

Resources

Association of Reproductive Health Professionals: Choosing a Contraceptive Method

http://www.arhp.org/methodmatch

National Osteoporosis Foundation

https://www.nof.org/patients/treatment/nutrition

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From NYT - Why WLS Works When Diets Don't

Don't shoot the messenger, I'm sharing this for my blog's historical reference because it's AMAZING INFORMATION -- and even if you "don't agree," because it's not your experience, it's science!

Via New York Times - https://nyti.ms/2kBVirc

“Bariatric surgery is probably the most effective intervention we have in health care,” says Laurie K. Twells, a clinical epidemiologist at Memorial University of Newfoundland. She bases this bold claim on her experience with seriously obese patients and a detailed analysis of the best studies yet done showing weight-loss surgery’s ability to reverse the often devastating effects of being extremely overweight on health and quality of life.

“I haven’t come across a patient yet who wouldn’t recommend it,” Dr. Twells said in an interview. “Most say they wish they’d done it 10 years sooner.” She explained that the overwhelming majority of patients who undergo bariatric surgery have spent many years trying — and failing — to lose weight and keep it off. And the reason is not a lack of willpower.

“These patients have lost hundreds of pounds over and over again,” Dr. Twells said. “The weight that it takes them one year to lose is typically back in two months,” often because a body with longstanding obesity defends itself against weight loss by drastically reducing its metabolic rate, an effect not seen after bariatric surgery, which permanently changes the contours of the digestive tract.

In reviewing studies that followed patients for five to 25 years after weight-loss surgery, Dr. Twells and colleagues found major long-lasting benefits to the patients’ health and quality of life. Matched with comparable patients who did not have surgery, those who did fared much better physically, emotionally and socially. They rated themselves as healthier and were less likely to report problems with mobility, pain, daily activities, social interactions and feelings of depression and anxiety, among other factors that can compromise well-being.

Equally important are the undeniable medical benefits of surgically induced weight loss. They include normalizing blood sugar, blood pressure and blood lipid levels and curing sleep apnea. Although bariatric surgery cannot cure Type 2 diabetes, it nearly always puts the disease into remission and slows or prevents the life-threatening damage it can cause to the heart and blood vessels.

 

Even in the small percentage of patients who ultimately lose little weight after surgery, significant metabolic benefits persist, according to findings at the Cleveland Clinic. In a study of 31 obese diabetic patients who had not lost a lot of excess weight five to nine years after surgery, a “modest” weight loss of just 5 to 10 percent resulted in a reduction of cardiovascular risk factors and blood sugar abnormalities, Dr. Stacy Brethauer and colleagues reported.

For the two most popular surgical techniques — the gastric bypass and the gastric sleeve — “the metabolic benefits are independent of weight loss,” Dr. Brethauer said in an interview. Both methods permanently reduce the size of the stomach. However, the gastric band procedure, which is reversible, lacks these benefits unless patients achieve and maintain significant weight loss, he said.

Furthermore, as a study last year of 2,500 surgical patients at the Veterans Affairs Medical Center in Durham, N.C., found, those who underwent bariatric surgery had lower overall death rates up to 14 years later than comparable patients who did not have weight-loss surgery.

Experts in the field regard the reluctance of some medical insurers, including Medicaid programs in many states, to cover the cost of bariatric surgery as a penny-wise, pound-foolish position. Failing to reverse extreme obesity can end up costing far more per patient than the typical $30,000 price tag of bariatric surgery — sometimes even millions of dollars more.

 

Counter to popular impressions that most people treated surgically regain most or all the weight they lose initially, the latest long-term research has shown otherwise. In a decade-long follow-up of 1,787 veterans who underwent gastric bypass, a mere 3.4 percent returned to within 5 percent of their initial weight 10 years later. This finding is especially meaningful because the researchers at the V.A. center in Durham were able to keep track of 82 percent of gastric bypass patients, a task too challenging for most clinics.

The study, by Matthew L. Maciejewski and colleagues published in August in JAMA Surgery, found that 10 years later, more than 70 percent of surgical patients lost more than 20 percent of their starting weight, and about 40 percent had lost more than 30 percent. Gastric bypass, an operation called Roux-en-Y, resulted in a somewhat greater weight loss at 10 years than the newer gastric sleeve surgery and significantly more than the adjustable gastric band (Lap-Band) surgery, which “has fallen out of favor in the last two or three years,” Dr. Maciejewski said.

 

Bariatric surgery, regardless of the method used, is also much safer nowadays than it was even a decade ago, said Dr. Jon C. Gould, a surgeon at the Medical College of Wisconsin in Milwaukee who wrote a commentary on the V.A. study. However, he noted, the surgery is “vastly underutilized,” to the detriment of patients’ health and the nation’s health care costs.

“Less than 1 percent who would qualify for bariatric surgery are actually getting it,” Dr. Gould said. “Although the vast majority have health coverage, insurance companies and many Medicaid programs put it out of reach for most people by demanding that they already have several obesity-related health conditions and are taking a slew of medications to control them.”

 

For example, he said, to be covered for bariatric surgery, Wisconsin Medicaid requires that a person with dangerously high blood pressure has to be taking three or more medications for it and still not have a normal pressure.

He cited a further deterrent to bariatric surgery: “a perception that it’s dangerous and doesn’t work,” beliefs countered by the research findings cited above. Most of the surgeries are now done laparoscopically through tiny incisions.

 

Given the well-documented safety and effectiveness of bariatric surgery, it is now increasingly being performed in people whose obesity is less severe — those with a body mass index (B.M.I.) of 35 or perhaps even less — but who have a metabolic disorder like Type 2 diabetes related to their weight.

In recent years, the profession has promoted what Dr. Gould calls “centers of excellence,” where 100 or more bariatric operations are usually done in a year. Practitioners at these centers “learn from experience, share their knowledge and push for quality improvements,” he said.

Dr. Gould suggested that people interested in bariatric surgery seek out programs that have been jointly accredited by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery, which have combined forces to promote quality control.

While experts agree that money would be better spent on prevention than treatment, Dr. Twells pointed out that “we have yet to find a way to prevent obesity, and people whose health is compromised by their weight deserve to be treated by the most effective method we have.”

 

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Mini product pre-review because I do things like that because babies suck the life out of you and we're not sleeping ever.

Bariatric Advantage Multi Chewy Bite Strawberry Watermelon

I tore into this package IN PARTICULAR out of all the bags that came my way - and all I am going to say right now because I am sleep deprived and losing my mind is Y - E - S.  

These little foil-wrapped multivitamin chews may very well solve my problems and save the world.  (Am I allowed to say that?  I DON'T CARE.  I AM TIRED.)

Bariatric Advantage?  Please create caffeine vitamins so that future reviews make sense.  

These little fruity-chew-Starburst-esque bites have nearly all the multivitamins a bariatric patient needs, in two chews.  They ARE Starburst-esque.  You unwrap a little square of fruit "candy" out of shiny foil wrapper, and it's reminiscent of candy, just slightly.  The taste is at first, berry, then watermelon.  There is a slight touch of vitamin, but not much as it's masked greatly by the fruit flavorings.  The taste profiles have improved a lot in the last few years.  

Check it out:

Multi Chewy Bites have been formulated to deliver a spectrum of essential nutrients to help address nutrient deficiencies common with pre- and post-surgery bariatric patients.* Available in two great flavors: Dark Cherry and Strawberry Watermelon. Individually wrapped in 60-count bags.

Key Features:

• Delivers 200% or more of the daily value on 16 key nutrients including:
• 5,000 IU of Vitamin A
• 3,000 IU of Vitamin D in D3 form—the preferred form of Vitamin D
• All B vitamins including 1,000 mcg Vitamin B12, 3 mg B1, and Folate
• Meets or exceeds American Society for Metabolic & Bariatric Surgery (ASMBS) guidelines—the foremost authority on bariatric science and nutrition

I am impressed.

• Product - Bariatric Advantage Multi Chewy Bites Strawberry Watermelon
• Via - Bariatric Advantage (Listed in the left hand sidebar under "New Multivitamins" 2/2017)
• Pros - Starburst-esque chews that are super easy to take, before AND after your weight loss surgery. 
• Cons - If you can't control yourself with chews, these ARE vitamins.  REMEMBER THAT.
• Rating - Pouchworthy